Thursday, November 10, 2016

Older Adults-Confidence About Law Enforcement and Courts?

I recently was called for jury duty. One of the questions asked during voir dire was about jurors' attitudes regarding the prospect of service. That made me think of a study I ran across recently, Measuring Older Adult Confidence in the Courts and Law Enforcement, published in Criminal Justice Policy Review.  The abstract for the article explains

Older adults are an increasingly relevant subpopulation for criminal justice policy but, as yet, are largely neglected in the relevant research. The current research addresses this by reporting on a psychometric evaluation of a measure of older adults’ Confidence in Legal Institutions (CLI). Confirmatory factor analysis (CFA) provided support for the unidimensionality and reliability of the measures. In addition, participants’ CLI was related to cynicism, trust in government, dispositional trust, age, and education, but not income or gender. The results provide support for the measures of confidence in the courts and law enforcement, so we present the scale as a viable tool for researchers and practitioners interested in understanding older adults’ confidence in these institutions. We conclude by discussing the implications of our work on efforts to improve interactions between older adults and legal institutions, and we highlight avenues for further research.

Here is a short excerpt from the conclusion:

Why is it that older, older adults report more confidence in the criminal justice system than younger, older adults? Does this reflect a cohort effect or individual differences? In addition, future research should examine whether these confidence subscales predict willingness to engage or actual engagement in legal activities such as jury service, reporting crimes (as a victim or witness), or initiating litigation as well as they do in more general samples

The full article published in the journal is available here for a fee.  A pre-publication pdf from ResearchGate is available here for free.

 

November 10, 2016 in Consumer Information, Crimes, Current Affairs | Permalink | Comments (0)

Wednesday, November 9, 2016

A Two-Question Quiz on The Timing For Your Retirement

The Wall Street Journal ran an article last month about a study that focused on people's decision-making regarding whether to retire.  Before Retiring, Take This Simple Test reports on study by "Philipp Schreiber and Martin Weber at the University of Mannheim in Germany, [where]  a simple two-question quiz [was developed] that can help predict whether you’ll regret the timing of your own retirement."  Two questions-that's pretty easy, right. Here we go, it won't take you long to answer them:

Question 1: You just learned that you are due a tax refund. If you’d like, you can get the $1,000 refund right away. Alternatively, you can get a $1,100 refund in 10 months. Which do you prefer?

Question 2: You just learned that you are due a tax refund. If you’d like, you can get a $1,000 refund in 18 months. Alternatively, you can get a $1,100 refund in 28 months? Which do you prefer?

How did you answer them? According to the article, "[t]he point of the exercise is to measure the consistency of a person’s time preferences. Someone with consistent time preferences should answer both questions the same way—choosing the early option both times, or the delayed option both times. Such consistency is a requirement for making financial plans that you stick with."  There are folks who don't answer consistently, and that's a red flag, the article explains. Those folks  "exhibit a tendency known as present bias, or hyperbolic discounting. They strongly prefer rewards that arrive right away." As for timing of retirement, the article notes that study shows that those who provided inconsistent answers ultimately regret the timing (too early) of their retirement.

The article suggests some positive applications of the study results. For those of us who participate in savings via payroll deductions, such programs could be improved "if they were personalized according to the results of the two-question quiz. Consider a person who exhibits a strong bias for receiving rewards in the present. Given the likelihood that she’ll be tempted by an early retirement, she might want to be defaulted to a higher savings rate during her working years. This will help her avoid future regret over the timing of her retirement decision, since she will have sufficient savings."  The article goes further, suggesting changes to enrollment in Social Security to minimize buyer's remorse for early retirement (evidently a lot of folks start drawing Social Security at age 62, which we all know results in a permanent reduction in benefits).

The study referenced in the WSJ article is reported in The Influence of Time Preferences on Retirement Timing. The abstract explains

This study analyzes the empirical relation between the decision when to retire and individuals time preferences. Theoretical models predict that hyperbolic discounting leads to dynamic inconsistent retirement timing. Conducting an online survey with more than 3,000 participants, we confirm this prediction. The analysis shows, that time inconsistent participants decrease their planned retirement age with increasing age. The temptation of early retirement seems to become stronger the closer retirement comes. We show that the negative effect of age is between 1.5 and 3 times stronger for participants who can be classified as hyperbolic discounters. In addition, we find that time inconsistent participants actually retire earlier. On average, the most time inconsistent participants retire about 2.2 years earlier. The time inconsistent behavior has severe consequences: Time inconsistent participants are ex post more likely to regret their retirement timing decision. Also, the unplanned early retirement leads to a constant decrease of retirement benefits of about 13%.

The full paper can be downloaded from the SSRN link here.

 

November 9, 2016 in Consumer Information, Current Affairs, Retirement, Social Security | Permalink | Comments (0)

Tuesday, November 8, 2016

Using Age-Progression Virtual Reality as an Incentive to Save

The Wall Street Journal recently published an article by Maddy Dychtwald, co-founder of Age Wave, on using virtual reality (VR) to help folks save. How Virtual Reality Can Boost Retirement Savings reports on a project and explains how it unfolded

Professor Hal Hershfield of UCLA’s Anderson School of Management partnered with Daniel Goldstein of Microsoft Research, Jeremy Bailenson, director of Stanford’s Virtual Human Interaction Lab, and several other Stanford researchers to see if connecting people with their future selves could affect their willingness to save for that future self. They took photos of college-age research subjects and digitally altered half of them to create virtual avatars at age 65—complete with jowls, bags under the eyes, and gray hair.

Why don't people do a better job of saving for retirement? According to the article, experts think it's psychological to some extent. "When you’re in your 20s and 30s, you can’t even imagine your life at 65 or 95. If you can’t imagine it, chances are you’re not planning for it."

Back tot he project.  Digitally aging the participants wasn't the end of the project. Next the participants were provided with "goggles and sensors and were dropped into virtual reality, where they faced a mirror reflecting either their current self or their future self. As part of the experiment, they were each given $1,000 to spend. They could either buy a gift for someone special, invest in retirement, plan a fun event, or put money into a checking account."

This is getting intriguing. Want to bet what happened? According to the article, "[t]hose research ...  greeted by their aged avatar put more than twice as much money toward retirement as those who saw their contemporaneous selves." The researchers, to double check the results, also showed "some research participants ... the aged avatars of other test subjects to see if that impacted their choices. It didn’t. Only those who saw themselves at retirement age were likely to invest in their future." 

The  WSJ article explains that VR tools are under development "to offer experiential solutions to our nation’s lack of retirement planning... [and] provide a visceral experience that might even immerse [the user] in several different future scenarios, so [the user] can experience, for instance, what it’s like to live with limited funds at 65, 75 or 80."

The article about the study, Increasing Saving Behavior Through Age-Progressed Renderings of the Future Self, is available here.

This is the abstract from the research study article:

Many people fail to save what they need to for retirement (Munnell, Webb, and Golub-Sass 2009). Research on excessive discounting of the future suggests that removing the lure of immediate rewards by pre-committing to decisions, or elaborating the value of future rewards can both make decisions more future-oriented. In this article, we explore a third and complementary route, one that deals not with present and future rewards, but with present and future selves. In line with thinkers who have suggested that people may fail, through a lack of belief or imagination, to identify with their future selves (; ), we propose that allowing people to interact with age-progressed renderings of themselves will cause them to allocate more resources toward the future. In four studies, participants interacted with realistic computer renderings of their future selves using immersive virtual reality hardware and interactive decision aids. In all cases, those who interacted with virtual future selves exhibited an increased tendency to accept later monetary rewards over immediate ones.

Wow, just wow.  Now, can we get these for our students?

November 8, 2016 in Consumer Information, Current Affairs, Retirement, Statistics | Permalink | Comments (0)

Monday, November 7, 2016

Federal District Court Enjoins Pre-Arbitration Dispute Rule

A federal district court in Mississippi has entered an injunction prohibiting the CMS rule against pre-dispute arbitration from taking effect at the end of  this month.  According to a story on NPR, "[t]he reason for granting the injunction, the court explained in its order, is that it believes the new rule represents "incremental 'creep' of federal agency authority" — in this case the Centers for Medicare & Medicaid Services — 'beyond that envisioned by the U.S. Constitution.'"

The 40 page order is available here.

 

November 7, 2016 in Consumer Information, Current Affairs, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid, Medicare | Permalink | Comments (0)

Sunday, November 6, 2016

Too Poor to Retire

Our local newspaper, the Tampa Bay Times, recently ran a story about elders who work at low-paying jobs. Although they may wish to retire, they find themselves unable to afford retirement.  For some low-income workers, retirement is only a dream explains that for low-wage workers can't afford to retire. "Studies have found that about one-third of low-wage workers ... say they'll never be able to afford retirement. The problem is particularly acute among minority women... mA 2016 study by the Associated Press-NORC Center for Public Affairs Research found that a quarter of workers 50 or older say they won't retire. Among low-wage workers, earning less than $50,000 a year, it was 33 percent."

Consider the following statistics:

A 2016 report by the nonpartisan research nonprofit National Institute on Retirement Security shows that many black, Hispanic and Asian women have to work past retirement age to be able to afford basic expenses. Women were 80 percent more likely than men to be impoverished.

The research showed that for men ages 70 to 74, about 19 percent of their income comes from wages. For women, it's about 15 percent.

Some low-wage workers will be able to collect Social Security, which will be of some help, but as the story notes, some without legal status won't be able to draw Social Security.  One of the individuals featured in the story is 70 years old and works 6 days a week as the caregiver a 100 year-old person.

So what happens if the low-wage worker falls ill and is unable to continue to work?  Might family step in to help? Are there options?

November 6, 2016 in Consumer Information, Current Affairs, Health Care/Long Term Care, Retirement, Social Security | Permalink | Comments (1)

Thursday, November 3, 2016

The Netherlands' Proposed Expansion of Aid-in-Dying

The Guardian ran a story last month about proposed legislation in the Netherlands for elders who aren't terminally ill, but instead believe they have lived long enough. Netherlands may extend assisted dying to those who feel 'life is complete' explains that "[t]he Dutch government intends to draft a law that would legalise assisted suicide for people who feel they have “completed life” but are not necessarily terminally ill."  Cabinet ministers have provided the Dutch Parliament with a letter about the plan, explaining "people who 'have a well-considered opinion that their life is complete, must, under strict and careful criteria, be allowed to finish that life in a manner dignified for them'."  The intent is to limit the law's application to elders "'because the wish for a self-chosen end of life primarily occurs in the elderly, the new system will be limited to' them." The article indicates that there would be safeguards in the law. The target for completing the draft legislation is the end of 2017. 

Stay tuned.

Thanks to Ron Hammerle for alerting me to the proposed legislation.

November 3, 2016 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Health Care/Long Term Care, International | Permalink | Comments (0)

Wednesday, November 2, 2016

Apple Enhances Accessibility in Products

Disability Scoop ran an article on November 1, 2016, Apple Doubling Down On Accessibility. Check this out:

Apple kicked off an event last week to unveil its latest lineup of MacBook Pros and other new offerings with a video showcasing the unique ways that people with disabilities use their products.

The brief clip shows individuals with physical and developmental disabilities using technology to overcome basic challenges — from speaking to learning, engaging with others and taking photographs.

Apple also unveiled its accessibility website, the landing page of which explains: "[t]he most powerful technology in the world is technology that everyone, including people with disabilities, can use. To work, create, communicate, stay in shape, and be entertained. So we don’t design products for some people or even most people. We design them for every single person."  The page offers links to accessibility features for each Apple product.

This you have to see. Check it out!

November 2, 2016 in Consumer Information, Current Affairs, Health Care/Long Term Care, Other, Web/Tech | Permalink | Comments (0)

Tuesday, November 1, 2016

Colorado: Two Sides on Aid-in-Dying Proposal

With just a few more days until the election, Coloradans are considering whether to vote in favor of physician aid-in-dying. Colorado Wrestles With Ethics Of Aid-In-Dying As Vote Looms published by Kaiser Health News (KHN) explains why some are supporting the measure, and others are opposing it.  As well, both sides are gathering large amounts of money to support their positions:

The ballot initiative is drawing passion — and plenty of money.

According to the latest filings with the Colorado Secretary of State’s office, backers have raised about $5.6 million, mostly from Compassion & Choices Action Network.

The “No Assisted Suicide Colorado” campaign has raised $2.4 million. That money is primarily coming from the Roman Catholic Archdiocese of Denver, which has donated $1.1 million, as well as other archdioceses around the country.

The Colorado Medical Society has taken a neutral position and the story offers some statistics about doctors' views of the measure, with a majority (although it's close) supporting the measure.

Stay tuned.

November 1, 2016 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Health Care/Long Term Care, State Statutes/Regulations | Permalink | Comments (0)

Monday, October 31, 2016

2017 COLA & Inflation: Not Keeping Up

SSA announced recently that there would be a COLA for 2017, but it is a teensy COLA, actually, a .03% increase. Big gap between Social Security cost-of-living adjustment and retiree inflation offers a critical look at the 2017 COLA compared to inflation and how the government calculates the COLA using the consumer price index. An article in USA Today about the 2017 COLA noted that this COLA won't allow beneficiaries to get ahead, even slightly. Instead, they will likely lose ground, because of the Medicare Part B premium costs

The nation’s 65 million Social Security beneficiaries will receive a paltry 0.3% cost-of-living adjustment to their monthly checks in 2017, the government announced Tuesday. In dollars and cents, it means the average retired beneficiary’s check will rise about $5 to $1,360 per month in 2017.

The even more bitter pill: Many current Medicare beneficiaries won’t be able to spend any of that extra money. Instead, they’ll likely have to send their COLA straight back to Uncle Sam to cover higher Medicare Part B premiums.

Almost a third of Medicare's 56 million beneficiaries could see their premiums jump 22% next year, according to the Medicare Trustees Report, putting the cost at an estimated $149 per month. Those unlucky 30% of beneficiaries include people enrolling in Part B for the first time in 2017, people who are on Medicare but who aren't currently taking Social Security benefits and current enrollees who pay an income-related higher premium.

October 31, 2016 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare, Retirement, Social Security | Permalink | Comments (1)

What is "Early Onset" Dementia?

Recently, San Diego residents learned the sad news that a much appreciated former coach of the Chargers football team, Marty Schottenheimer, age 73, has Alzheimer's Disease.  The article I read called it "early onset Alzheimer's."  Apparently the original diagnosis was made in 2011, when retired Coach Schottennheimer was approximately age 68.  Our wishes to "Coach Marty" and his family. 

It is, perhaps, also appropriate to point out that "early onset dementia" is different than than "early diagnosis of dementia." Medical experts typically refer to early onset dementia (sometimes EOAD for Alzheimer's type dementia) only for individuals age 65 or younger, often in a person's 50s, or even earlier.  

As an example from the sports world, legendary University of Tennessee women's basketball coach, Pat Summitt, publicly revealed her diagnosis of "dementia, Alzheimer's type," in 2011, at age 59.  She continued as the head coach for another academic year, before electing to retire (with, in her words, a "small r").  

In the last chapter of her third book, Sum It Up, Pat wrote movingly about her final year of coaching and the impact of her diagnosis, also admitting that she had probably been functioning "well" with Alzheimer's for about three years before she, with the help of her son, sought a diagnosis.  She explains how the fact of her diagnosis also led them to explore treatments and management techniques they might otherwise have ignored.  

As larger numbers of adults are living longer, I think we are hearing more frequently directly from persons in high positions about diagnoses of Alzheimer's or other neurocognitive impairments. This is important, because when healthy-living sports heroes are affected, we are more likely to pay attention and seek answers for everyone.  Whenever I see such news, even as I'm sad, I admire the courage of the speakers and am grateful for their candor. Seeing famous people continue to function, make realistic plans, and enjoy life is important for the "not-so-famous" too.  Their public candor highlights the critical need for discovery of preventions and cures for everyone.  

I suspect that when a member of the press -- or the nonmedical public -- refers to "early onset Alzheimer's," it is a reflection of hope, hope that any diagnosis at 70, 75, or even 80 must be unusual, rare, and therefore not a threat to "me" before some magically "older" age that is still far off, in the future.  

October 31, 2016 in Cognitive Impairment, Consumer Information, Dementia/Alzheimer’s, Retirement | Permalink | Comments (0)

Self Awareness, Courage and Cognitive Impairment

The Washington Post recently had a good article titled Facing Financial Reality When Early Dementia is Diagnosed.  It begins with Chuck McClatchey's realization that something was wrong: 

He moved to Fort Worth at age 61 with his partner Bobbie Duncan, and they spent $25,000 in savings on a fixer-upper house. His plan was to work until he was 70. But then things got strange. “I was having trouble understanding new technologies and things that I should have known off the top of my head” and having trouble using Word and Excel and PowerPoint, “things I had known for years."

 

He left that job but had problems in another, simpler job at Lowe’s.

 

Then one day, amid growing confusion, came clarity.

 

“I brought home a little desk for me to put together,” he said. “I love to put things together, the more complicated the better.” It should have taken about half an hour. Instead, two hours later, “the pieces just weren’t going together like I thought they should.”

 

Duncan finally said what they both knew. He needed to see a doctor about what was going on in his brain. The diagnosis was Alzheimer’s. . . . 

McClatchey's early diagnosis allowed him to get help while he was still well able to participate in planning.  He applied for Social Security disability at age 61 and also became an "early stage advisor" for the the Alzheimer's Association.  

Reading this article reminded me of a good friend who also received a diagnosis of Alzheimer's at an early stage.  Betty has often inspired me by how she has approached this fact. She quietly told friends of her diagnosis, but she did not retreat from life. Betty stays engaged and has a full social life. She has made critical accommodations -- she keeps a daily journal to help with tasks and memory --  and her children have rallied to support and help her, while still giving her as much autonomy as possible. Indeed, her family was instrumental in these changes as they insisted on that first evaluation, rather than brushing away early warning signs as merely due to stress.  Thus, "self awareness" of both Betty and her family has been essential in creating a short and long range plan for the future.

The Post article also suggests that not every financial professional is skilled at recognizing how to help individuals with cognitive impairments, whether diagnosed or undiagnosed.  I think this is true for attorneys and other professionals as well. Good intentions alone are not enough.  From the article: 

Being good with money isn’t the only skill required to help dementia sufferers. Corey Purkat, an Oakdale, Minn., financial planner, found himself unable to help a couple in their 80s who hired him to help sort things out in the early stages of the wife’s dementia. She had been a financial professional whose memory issues rapidly worsened. As they did, “she got defensive that someone would have to help her with something she had done for a living.” That put more stress on her husband, who decided “he wasn’t up to making the hard decisions.”

 

“I did what I could, and I did the best I could,” he said of their amicable parting. But if a similar case comes up in the future, he said, “my goal is to refer them to someone with more experience” with dementia.

It takes courage to get a diagnosis when early, subtle warning signs appear.  It takes courage to help a family member get that diagnosis. Our thanks to George Washington Law Professor Naomi Cahn for sharing the link to this and other timely Washington Post articles. 

October 31, 2016 in Advance Directives/End-of-Life, Cognitive Impairment, Dementia/Alzheimer’s, Estates and Trusts, Ethical Issues | Permalink | Comments (0)

Sunday, October 30, 2016

Geography and the Costs of Care At the End of Life

The New England Journal of Medicine published a study that shows by region where people spend more time at home at the end of life. Days Spent at Home — A Patient-Centered Goal and Outcome notes that

Being home at the end of one’s life will never be a universal goal, but our experience and academic research suggest that, all else being equal, patients would rather be at home than in health care facilities. When surveyed about their preferences for dealing with a terminal illness, most people (86%) indicated that they would prefer to be at home in their final days. In addition, they would not want to be on a ventilator in order to gain an extra week of life, and they are not opposed to drugs that could improve symptoms but potentially shorten life. These preferences are highly consistent across regions of the country and people’s socioeconomic status.1 Despite this consistency in end-of-life preferences, there is wide regional variation in the intensity of, expenditures on, and locations of care provided during the last 6 months of life.

(citations omitted)

The Wall Street Journal reported on the study. Where the Elderly Die Can Vary by Region, Study Shows explains that

How much time people spend in hospitals or nursing homes in the final months of life, instead of at home, varies widely depending on where they live, new research shows.

Across the Rockies and regions of the Gulf Coast, the dying spend more than two additional weeks hospitalized or in other facilities, on average, compared with those at the end of life in the Midwest and Montana, researchers reported Wednesday in the New England Journal of Medicine.

In other parts of the country, the picture is more mixed but still differs sharply from one community to another.

The study also looks at the differences in Medicare spending as a result of the regional variations. "Research suggests one reason for the geographical spending swings may be that doctors practice medicine differently in some areas of the country than others, with some doctors doing more despite little difference in results."  Even in some instances where the patient's care was supposed to be delivered at home, that didn't occur.  "The ... study also found that health-care and hospice services intended to keep people at home perhaps did not do so. Regions where use of home care and hospice were greater also had higher use of hospitals and nursing homes ...."

October 30, 2016 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care | Permalink | Comments (1)

Thursday, October 27, 2016

ACL Releases Independent Living Regs

The Administration for Community Living (ACL) released on October 26, 2016 the unpublished final regulation for independent living programs (the reg is officially published on October 27, 2016). The rule is effective November 25, 2016.

The discussion section explains the new rule

The federal Independent Living (IL) program seeks to empower and enable individuals with disabilities, particularly individuals with significant disabilities, to exercise full choice and control over their lives and to live independently in their communities. For over 40 years, these aims have been advanced through two federal programs: Independent Living Services (ILS) and Centers for Independent Living (referred to as CILs or Centers). The Workforce Innovation and Opportunity Act (WIOA) transferred these Independent Living programs to the Administration for Community Living (ACL) and created a new Independent Living Administration within the agency, adding section 701A of the Rehabilitation Act, 29 U.S.C. 796-1.

According to the ACL news release, the new regs:

  • Clarifies requirements surrounding WIOA’s addition of new core services to:
    • Facilitate the transition of individuals with significant disabilities from nursing homes and other institutions to home and community-based settings
    •  Provide assistance to individuals with significant disabilities who self-identify as being at risk of entering institutions so that the individuals may remain in the community
    • Facilitate the transition of youth with significant disabilities who are no longer in school and no longer receiving services under section 614(d) of IDEA.
  • Clarifies several key definitions. For example:
    • “Consumer control” adds specificity to definition in the context of individuals to mean that the person with a disability has control over his or her personal life choices, independent living plan and has the right to make informed choices about content, goals and implementation. Prior to the final rule, “consumer” was sometimes interpreted to include the parents or caregivers of the person with a disability
    • “Personal assistance services” is now defined to explicitly include assistance with activities outside of employment, such as social activities and parenting.
  • Addresses the roles and responsibilities of the State Independent Living Council, as defined by WIOA. For example, the final rule:
    • Includes additional details of what must be a part of the SILC Resource Plan to carry out the functions of the SILC
    • Addresses the SILC’s authority to conduct resource development activities to support the provision of services by Centers for Independent Living
    • Clarifies the expanded role of the SILC in the development of the State Plan for Independent Living.

 

 

October 27, 2016 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Housing | Permalink | Comments (0)

Wednesday, October 26, 2016

DOJ Settles False Claims Case vs. SNF

DOJ announced recently that it had settled a False Claims case against Life Care Centers of America Inc. (Life Care) and its owner, Forrest L. Preston. The defendants agreed to pay $145 million to settle a case where the Government claimed “that Life Care violated the False Claims Act by knowingly causing skilled nursing facilities (SNFs) to submit false claims to Medicare and TRICARE for rehabilitation therapy services that were not reasonable, necessary or skilled….” In addition, the defendant also signed a Corporate Integrity Agreement with the Office of Inspector General (HHS-OIG) for HHS. Under this 5 year agreement, “an independent review organization [will] … annually assess the medical necessity and appropriateness of therapy services billed to Medicare” by the defendant.  The suit was brought pursuant to the whistleblower provision of the False Claims Act.

According to the suit, the defendant put corporate-wide procedures and polices into place that caused a maximum number of “beneficiaries in the Ultra High reimbursement level irrespective of the clinical needs of the patients, resulting in the provision of unreasonable and unnecessary therapy to many beneficiaries.” Further the defendant tried to keep SNF residents longer than needed so the defendant could continue to bill for rehab, even though the therapists concluded therapy should be ended. The defendant kept careful track of the therapy minutes per patient and the patient’s therapy days so that the maximum number of patients were at that “highest level of reimbursement for the longest possible period.”

According to an email I received, the amount of the settlement was partially based on statistical sampling.

Thanks to Laurence Hooper for emailing me.

October 26, 2016 in Consumer Information, Crimes, Current Affairs, Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare | Permalink | Comments (0)

Tuesday, October 25, 2016

Refusing Foods & Fluids as a Right to Die?

The New York Times ran an article recently on individuals voluntarily refusing nutrition and hydration as a way to speed up the end of life. The VSED Exit: A Way to Speed Up Dying, Without Asking Permission focuses on individuals who voluntarily give up eating and drinking. We know that only a handful of states offer Physician-Aided Dying and even in states where that is legalized, not everyone fits within the parameters of the statute.  "In end-of-life circles, [the] option [voluntarily giving up food and fluids] is called VSED (usually pronounced VEEsed), for voluntarily stopping eating and drinking. It causes death by dehydration, usually within seven to 14 days. To people with serious illnesses who want to hasten their deaths, a small but determined group, VSED can sound like a reasonable exit strategy."

The article notes that for individuals who avail themselves of VSED, no law seems to be needed (although there is still some uncertainty on that point), no court intervention is required, but the individual needs a lot of fortitude, “'It’s for strong-willed, independent people with very supportive families,' said Dr. Timothy Quill, a veteran palliative care physician at the University of Rochester Medical Center." 

One unanswered question is whether VSED is "legal".

For a mentally competent patient, able to grasp and communicate decisions, probably so, said Thaddeus Pope, director of the Health Law Institute at Mitchell Hamline School of Law in St. Paul, Minn. His research has found no laws expressly prohibiting competent people from VSED, and the right to refuse medical and health care intervention is well established.

Still, he pointed out, “absence of prohibition is not the same as permission.” Health care professionals can be reluctant to become involved, because “they want a green light, and there isn’t one of those for VSED,” he added.

The question grows much murkier for patients with dementia or mental illness who have specified VSED under certain circumstances through advance directives. Several states, including Wisconsin and New York, forbid health care surrogates to stop food and fluids. (Oregon legislators, on the other hand, are considering drafting a bill to allow surrogates to withhold nutrition.)

The article reports on a recent conference and some of the issues discussed there.  The article also explains that with VSED, death doesn't come as quickly as with PAD, leading to issues for patients and caregivers. The article also notes there are (or likely could be) obstacles to using VSED, such as positions taken by long term care facilities or specific religions.

This topic would be great for a class discussion.

 

October 25, 2016 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Health Care/Long Term Care, Programs/CLEs, State Statutes/Regulations | Permalink | Comments (1)

Monday, October 24, 2016

LGBTQI Elders & the Challenges of Staying Out?

Kaiser Health News ran a story, Staying Out Of The Closet In Old Age. The article explores the issues faced by elders who are out and become frail and need caregivers or supportive housing.  How significant are the issues faced by these elders? According to one expert quoted in the article, very.

“It is a very serious challenge for many LGBT older people,” said Michael Adams, chief executive officer of SAGE, or Services and Advocacy for Gay, Lesbian, Bisexual and Transgender Elders. “[They] really fought to create a world where people could be out and proud. … Now our LGBT pioneers are sharing residences with those who harbor the most bias against them.”

Efforts are underway to move long term care providers to a point of understanding. Such efforts include

Nationwide, advocacy groups are pushing to improve conditions and expand options for gay and lesbian seniors. Facilities for LGBT seniors have opened in Chicago, Philadelphia, San Francisco and elsewhere.

SAGE staff are also training providers at nursing homes and elsewhere to provide a more supportive environment for elderly gays and lesbians. That may mean asking different questions at intake, such as whether they have a partner rather than if they are married (even though they can get married, not all older couples have).  Or it could be a matter of educating other residents and offering activities specific to the LGBT community like gay-friendly movies or lectures.

The article mentions a report this summer from Justice in Aging (formerly the National Senior Citizens Law Center), How Can Legal Services Better Meet the Needs of Low-Income LGBT Seniors? in which it was reported that 1/5  of those elder LGBTQI individuals in LTC facilities felt ok with being open about being an LGBTQI elder.

The article discusses the difficulty in finding housing and reports on some options that have developed, such as "the Los Angeles Gay & Lesbian Elder Housing organization opened Triangle Square Apartments in 2007. In the building, the first of its kind, residents can get health and social services through the Los Angeles LGBT Center. The wait for apartments with the biggest subsidies is about five years."

 

October 24, 2016 in Consumer Information, Current Affairs, Discrimination, Health Care/Long Term Care, Housing | Permalink | Comments (1)

Sunday, October 23, 2016

Abuse of Elder Mothers

The National APS Resource Center released a new research brief, Elder Abuse, Mother Abuse & Parenting in Later Life. The focus of the brief is older mothers with adult children who are described as difficult. "The sample is low income and minority older women 62 years and older. All of the women had allowed their adult children to move back into the family home when the adult children had [become] unable to support themselves due to mental health issues, break up of a romantic relationships or unemployment." The brief explains the stress these mothers undergo and the reasoning for why the mothers allowed their children to move back in with them and why they don't make the children move out once problems occur.  Consider this from the brief,

A surprising finding is that none of the women ever used the word “abuse,” including those who had contacted law enforcement and/or had obtained an order of protection. Instead, they presented themselves as mothers who made the decision to protect their adult children over their own personal comfort or safety.

As far as policy implications, "[a] surprising finding is that none of the women ever used the word “abuse,” including those who had contacted law enforcement and/or had obtained an order of protection. Instead, they presented themselves as mothers who made the decision to protect their adult children over their own personal comfort or safety. "  The brief suggests that APS workers and elder mothers develop a "safety plan" for addressing both the mother and child's needs.

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October 23, 2016 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship | Permalink | Comments (0)

Friday, October 21, 2016

LeadingAge's Annual Meeting Begins October 30 in Indianapolis

LeadingAge, the trade association that represents nonprofit providers of senior services, begins its annual meeting at the end of October.  This year's theme is "Be the Difference," a call for changing the conversation about aging.  I won't be able to attend this year and I'm sorry that is true, as I am always impressed with the line-up of topics and the window the conference provides for academics into industry perspectives on common concerns.  For example, this year's line up of workshops and topics includes:

October 21, 2016 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Discrimination, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, International, Legal Practice/Practice Management, Medicaid, Medicare, Programs/CLEs, Property Management, Retirement, Science, Social Security, State Cases, State Statutes/Regulations, Veterans | Permalink | Comments (2)

Thursday, October 20, 2016

Geripal Podcast-Bed Alarms

Should Judges Have Mandatory Retirement Ages? What's the "Right" Number?

Generally speaking, I'm not a fan of mandatory retirement based on age alone, whether for judges or other professions.  In a perfect world, merit-based criteria should be the issue, not age.  At the same time, as a full-time practicing lawyer before becoming a full-time academic, I was all too familiar with judges who stayed on the court too long. Indeed, I had the challenging (okay, make that very challenging) experience of trying to help my own father, who as a federal judge had a lifetime appointment, make the decision to retire.  The whole family was involved, but it needed to happen.

During the primary elections in Pennsylvania during the spring, there was an initiative that appeared on the ballot in my voting precinct about mandatory retirement for judges.  The spring initiative read:

Shall the Pennsylvania Constitution be amended to require that justices of the Supreme Court, judges and justices of the peace (known as magisterial district judges) be retired on the last day of the calendar year in which they attain the age of 75 years, instead of the current requirement that they be retired on the last day of the calendar year in which they attain the age of 70?

The language, I thought, was clear, as it was a proposal to increase the mandatory retirement age from 70 to 75 for members of the Pennsylvania judiciary.  I voted yes, knowing that many of the most capable judges were still in their prime at 70+  

However, a behind-the-scenes compromise, involving partisan politics in the state legislature, was in the works on the language, and as it turned out our primary votes simply were not counted on the above initiative.  Instead, in  the upcoming general election the following initiative will appear:

Shall the Pennsylvania Constitution be amended to require the justices on the Supreme Court, judges, and magisterial district judges be retired on the last day of the calendar in which they attain the age of 75 years?  

Does this replacement language fairly explain the choices to the average voter? I'm not the only one who thought the new language was less than candid. I was impressed by the stand taken by former Pennsylvania Supreme Court Justice Ronald Castille, who was in favor of the higher age and reportedly had not wanted to retire at 70, but who didn't like  the hide-the-ball tactics.  He joined others and challenged the language.   His word for the tactic?  "Deceitful."

Who had the final say on which language would be used?  Ironically, the Pennsylvania Supreme Court.  In its September ruling, the Court was split 3 to 3 on the issue, which allowed the "new" language to stand.  

October 20, 2016 in Cognitive Impairment, Current Affairs, Discrimination, Ethical Issues, State Cases, State Statutes/Regulations | Permalink | Comments (0)